Ohle R, et al. - Given that acute aortic dissection (AAD) is a time-sensitive, difficult to diagnose, aortic emergency, the quality of history taking in AAD was assessed and its impact on misdiagnosis was determined. A retrospective cohort of 194 cases of acute aortic dissection (a mean age of 65(SD 14.1) and 66.7% male) who presented to two tertiary care emergency departments from January 1, 2004 – December 31, 2012, was studied. Among these, 34 (17.6%) were missed on the initial presentation. Researchers hey defined the definitions of 5 pain characteristics—character, onset, duration, quality, and radiation—as a priori. All 5 questions were asked in only 20 (14.8%) patients. Acute coronary syndrome (16, 47%), pulmonary embolism (5, 14.7%) and stroke (4, 11.7%) were the most common initial incorrect diagnosis. One in five cases were missed in case < 2 questions were asked, 4 times greater than if > 2 were asked. Based on these findings, they recommend clinicians to ask and document the character, onset, duration, radiation and severity of pain in any patient presenting with chest, abdominal or flank pain. This emphasizes the significance of a focused history in reducing misdiagnosis.